How does dialysis replace kidney function, and how long can people live on it?

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1. 1

   Kidney dialysis (Wikipedia)

   WikipediaPublished Oct 10, 2026Checked Oct 11, 2026

   “Kidney dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. Along with kidney transplantation, it is a type of renal replacement therapy. Dialysis may need to be initiated when there is a sudden rapid loss of kidney function, known as acute kidney injury (previously called acute renal failure), or when a gradual decline in kidney function, chronic kidney failure, reaches stage 5. Stage 5 chronic renal failure is reached when the glomerular filtration rate is less than 15% of the normal, creatinine clearance is less than 10 mL per minute, and uremia is present. Dialysis is used as a temporary measure in cases of acute kidney injury or for those awaiting kidney transplant and as a permanent measure in those for whom a transplant is not indicated or not possible. In West European countries, Australia, Canada, the United Kingdom, and the United States, dialysis is paid for by the government for those who are eligible. The first successful dialysis was performed in 1943.”

2. 2

   Dialysis modality and survival in octogenarians: real-world population-based cohort study.

   Clinical kidney journal (Toapanta et al.)Published Jul 15, 2026Checked Oct 11, 2026

   “A 1:3 propensity score-matched analysis was performed. Transition from PD to HD was modeled as a time-dependent covariate in Cox proportional hazards models to account for modality switching and minimize immortal-time bias.ResultsAmong 4205 octogenarians, 239 initiated PD, 3966 initiated HD. After matching, 213 PD patients were compared to 637 HD controls. Five-year survival did not differ significantly by initial modality after adjustment. However, switching from PD to HD was independently associated with increased mortality (HR 1.46; 95% CI 1.02-2.08; P = .038), suggesting a potential association with clinical deterioration. PD without switching was not significantly associated with mortality (HR 1.19; P = .120; 95% CI 0.95-1.48). Older age and KRT initiation in 2000-07 were also associated with worse outcomes.ConclusionsIn this large population-based cohort of octogenarians, initial dialysis modality was not associated with differences in survival after adjustment. However, transition from PD to HD was associated with higher mortality, underscoring the importance of dynamic monitoring and ongoing clinical reassessment in peritoneal dialysis.”

3. 3

   Personalized survival prediction in elderly dialysis patients: integrating machine learning with traditional survival analysis.

   BMC nephrology (Huerfano et al.)Published Jul 13, 2026Checked Oct 11, 2026

   “Survival was assessed using Kaplan-Meier and Cox proportional hazards (Cox PH) models. Five ML survival methods including Penalized Cox, Random Survival Forest (RSF), gradient boosting accelerated failure time (XGB-AFT), DeepSurv, and DeepHit were evaluated on an independent test set using time-dependent concordance (C-index) and the integrated Brier score (IBS). Uncertainty was quantified using non-parametric bootstrap 95% confidence intervals.ResultsHD was associated with improved survival compared with PD (HR = 1.36, 95% CI: 1.20-1.53; p ConclusionsHemodialysis is associated with a survival advantage in elderly dialysis patients. Integrating ML with classical survival analysis improves individualized prognostic assessment and highlights prognostic factors such as vascular access and nutritional/inflammatory status. These findings may inform precision medicine approaches to dialysis planning and patient-centered management.”

4. 4

   Over 500 000 people on kidney replacement therapy in the European Union.

   Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - EuropPublished Aug 1, 2026Checked Oct 11, 2026

   “It is forecast to become the fifth most common global cause of death and the third in western Europe by 2050. It is estimated that 511 549 European Union (EU) inhabitants depend on KRT, with nearly two-thirds (≈310 000) treated by dialysis, and the remainder being kidney transplant recipients (≈200 000). KRT is provided by every EU country. France (96 317), Germany (77 900), Spain (67 604), and Italy (62 523) account for 60% of people on KRT in the EU. Prevalence per million population ranged from 560 (Luxembourg) to 2022 (Portugal). Germany (55 129) leads in the number of people on dialysis, followed by France (52 817), Italy (44 382), and Spain (29 879). In addition to differences in the relative number of dialysis and transplant patients, there were also EU-wide differences in modality of dialysis. The hemodialysis/peritoneal dialysis prevalence ratio ranged from 52.0 (Slovakia) to 3.4 (Sweden). The EU should be aware of the burden of KRT when designing regulations, such as the Accelerating Clinical Trials in the EU (ACT EU) and the EU Medical Device Regulation (MDR) or making decisions regarding the prioritization of diseases and the budget for research and healthcare.”

5. 5

   Personalized Hemodialysis Approaches in Frail Older Individuals.

   Geriatrics (Basel, Switzerland) (Gembillo et al.)Published Apr 7, 2026Checked Oct 11, 2026

   “It is consistently associated with older age, female sex, diabetes, lower serum albumin, cardiovascular disease, longer dialysis vintage, and lower physical activity. Compared with non-frail patients, frail hemodialysis patients have a substantially higher risk of death (approximately two-fold in pooled analyses). Seminal trials and large observational programs that shaped hemodialysis targets underrepresented very old, frail, and highly comorbid patients, limiting generalizability. In frail older adults with limited life expectancy and substantial comorbidity burden, standard thrice-weekly schedules, higher ultrafiltration intensity, and a uniform 'fistula-first' approach may increase treatment burden without clear proportional gains in patient-centered outcomes. This review examines evidence supporting individualized hemodialysis strategies in frail older adults. As the dialysis population continues to age, proficiency in goal-concordant, personalized prescribing is increasingly important for nephrologists and dialysis teams.”